Lance T. Vernon to use five-year, $650,000 grant
from the National Institute of Dental and Craniofacial
Research

Patients with HIV, who are taking a cocktail of life-saving medicines,
may be at risk for developing heart disease at an accelerated rate.
This situation may provide a unique opportunity to study the link between
oral health and heart disease.

Lance T. Vernon, DMD, MPH, a researcher from the Case Western Reserve
University School of Dental Medicine, has received a five-year, $650,000
grant from the National Institute of Dental and Craniofacial Research
(part of the National Institutes of Health). He will follow 150 HIV
patients across two years to examine their oral health and track changes
in their systemic health for the study, “Oral Link to Vascular
Disease in an HIV-1 Cohort.”

“If we can show that there is a link between periodontal (gum)
disease and heart disease in this cohort, it will further the evidence
that oral health is very much connected to general health,” said
Vernon. “If so, then more effective control of periodontal disease
may well lower the risk of heart disease, especially in at-risk populations
such as those with HIV.”

Many HIV patients control their disease with a drug regimen known as
HAART (highly active antiviral regiment therapy). This regimen adds
years of life, but can also have side effects that speed up the development
of heart disease. “One study has shown that those with HIV taking
HAART have changes in their blood vessels at almost 10 times the rate
of those without HIV,” said Vernon. “Changes that might
take a decade to occur in otherwise healthy individuals may be detectable
in just a few years in this cohort.”

Growing evidence from studies within the dental community has shown
a link between the bacteria which cause periodontal disease and heart
disease. The exact mechanism is unclear but, Vernon said, this study
may help shed light on that link.

Vernon will test for the presence of three predominant bacteria (Treponema
denticola, Porphyromonas gingivalis and Bacteroides forsythus) associated
with periodontal disease. Using modern technology to look at the bacterial
DNA, he will be able to determine the presence of bacteria from samples
of plaque taken from below the patient’s gum-line.

His hypothesis is that, in his cohort and across two years, those with
high levels of periodontal disease will accelerate the rate of progression
towards atherosclerosis, as compared to those with lower levels of periodontal
disease.

In addition to looking at oral health parameters, patients will also
be tested for their insulin sensitivity, lipid levels, percent body
fat, diet, level of exercise, quality of life and inflammatory markers
in their blood. An ultrasound machine will be used to test the functioning
of arteries in the arm and the size of arteries in the neck, since both
are early warning signs of the hardening of the arteries and a risk
factor for heart attacks and strokes.

Eligible patients will be recruited from the Cleveland Clinic, MetroHealth
Medical Center, the Center for Aids Research at University Hospitals
of Cleveland and the Louis Stokes Veterans Administration Hospital.

The grant also is a career development award that enables Vernon to
take doctoral-level courses related to his area of research. Throughout
the study, he also will work alongside mentors from Case School of Medicine
and University Hospitals, such as Michael Lederman from the Center for
Aids Research; Chris Whalen from the Department of Epidemiology and
Infectious Diseases; Ravi Nair, from Division of Cardiology, and Zahra
Toossi from the Infectious Disease Core Laboratory. His mentors from
the Case School of Dental Medicine include Aaron Weinberg, chair of
biological sciences, and Nabil Bissada, chair of the department of periodontics.

About Case Western Reserve University

Case is among the nation's leading research institutions. Founded in 1826
and shaped by the unique merger of the Case Institute of Technology and Western
Reserve University, Case is distinguished by its strengths in education, research,
service, and experiential learning. Located in Cleveland, Case offers nationally
recognized programs in the Arts and Sciences, Dental Medicine, Engineering,
Law, Management, Medicine, Nursing, and Social Work. http://www.case.edu.